1003995424 NPI number — BEALER CHIRO PLUS, LLC

Table of content: (NPI 1003995424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003995424 NPI number — BEALER CHIRO PLUS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEALER CHIRO PLUS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003995424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7842 BOYERTOWN PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19512-8109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-689-3700
Provider Business Mailing Address Fax Number:
610-689-4467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7842 BOYERTOWN PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19512-8109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-689-3700
Provider Business Practice Location Address Fax Number:
610-689-4467
Provider Enumeration Date:
11/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEALER
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
JUSTINE
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
610-689-3700

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC009161 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 076809RXF . This is a "MEDICARE PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 076809UWA . This is a "MEDICARE PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50057700 . This is a "CAPITAL BC GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1064067 . This is a "AMERICAN SPECIALTY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1107802 . This is a "AETNA HMO #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7097799 . This is a "AETNA PPO GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2620475000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50057698 . This is a "CAPITAL BC PRACTITIONER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7694759 . This is a "AETNA PPO PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: BE1783140 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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